What's in store for policyholders after GE removes pre-authorisation letters for two private hospitals
GE temporarily stopped issuing pre-authorisation certificates for admissions to Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital from June 17.
SINGAPORE - Some policyholders of Great Eastern (GE) found themselves in a pickle after the insurer temporarily
stopped issuing pre-authorisation certificates for admissions to Mount Elizabeth hospitals from June 17.
Policyholders will now have to re-evaluate whether they want to go to Mount Elizabeth Hospital or Mount Elizabeth Novena Hospital for treatment; switch to another private hospital; or change insurance provider altogether.
The incident has also highlighted the need for a separate pool of funds for unexpected medical expenses, even though the verdict on such a fund is mixed.
Integrated Shield Plan (IP) holders of GE policies have to make some choices now that pre-authorisation for planned medical procedures has been suspended at the two Mount Elizabeth hospitals. Pre-authorisation is not required for emergency situations, where immediate medical attention is needed.
Mr Alex Lee, president of the Singapore Actuarial Society (SAS), said those who still decide to go to the two hospitals for treatment will have to foot the bill out of their own pockets first and claim it back later.
Mr Lee added that GE may reimburse the claim if it is deemed as reasonable. This will be no different from the scenario in which the policyholder has received pre-authorisation for the medical procedure.
However, the insurer could also reject the claim if the treatment is excluded under the policy conditions, he said.
Mr Kyith Ng, senior solutions specialist at insurance advisory firm Havend, said these GE policyholders will have to face the uncertainty over whether their insurance will cover their hospital expenses and how much of the bill it will cover.
SAS' Mr Lee said other policyholders, who want peace of mind before their medical treatment starts, could choose to move to another private hospital where GE continues to offer pre-authorisation for admissions.
There are eight private hospitals in Singapore, including the two Mount Elizabeth ones: Gleneagles, Parkway East, Farrer Park, Raffles, Thomson Medical Centre and Crawfurd Hospital. There is also one private not-for-profit hospital, Mount Alvernia.
The process of pre-authorisation allows an insurer to assess whether a medical procedure recommended by the doctor is necessary and at a reasonable cost, said Associate Professor Chen Renbao from the department of finance at the National University of Singapore (NUS) Business School.
Upon approval, policyholders have a gauge of the estimated treatment costs and know how much their insurance policy will cover prior to hospitalisation.
There are some GE policyholders who are contemplating whether to switch to another insurance provider. They can do so if they do not have pre-existing illnesses, which will exclude these medical conditions from any new insurance coverage.
One policyholder who wishes to remain anonymous told The Straits Times that his entire family uses Mount Elizabeth hospitals. He is thinking of switching to another IP insurer but is concerned about any exclusions that will not be covered.
He told ST that GE should not impose such restrictions on existing policyholders and that these restrictions should only apply to new ones.
Of the seven private insurers that offer IPs, Income and Singlife do not offer pre-authorisation for medical procedures.
The other four, AIA, Prudential, HSBC Life and Raffles Health, do but Havend's Mr Ng said there is no certainty they will continue to do so.
'What GE does may make the other insurers wonder if they can do the same,' he added.
If policyholders switch insurers and that insurer later makes changes to its claims policy, they could be caught in a bind, Mr Ng noted.
Health insurance provides a safety net against unexpected health issues and offers individuals and their families protection in case major medical treatment becomes necessary.
Mr Ng said an individual could build up savings specific for medical needs as another safety net.
The fund can be used to pay any pre-hospitalisation procedures such as scans, blood tests or post-hospitalisation expenses like physiotherapy or speech therapy.
Policyholders have to pay pre- and post-hospitalisation expenses in cash and then submit the claims for approval, Mr Ng added.
Furthermore, some claims might take longer than usual to process.
Mr Ng has seen cases drag out for as long as six months. Claimants will face a cash-flow crunch if they do not set aside enough cash on hand, he added.
There are situations where individuals will need to pay medical costs upfront, though this is not always so, Mr Ng noted, adding that they just need to ensure they have an adequate amount to supplement those needs.
Otherwise, they may be compelled to use the money set aside for other purposes, like their children's education or their own retirement.
'The money has to come from somewhere.'
So, by setting aside say $20,000, individuals know how much money they have for such exigencies and will not have to take the money from their other financial funds, Mr Ng said.
However, Associate Professor Walter Theseira from the Singapore University of Social Sciences, said it is not efficient for most people to maintain 'substantial funds in cash for medical needs', given that these are infrequent and large.
He said the point of having more comprehensive insurance is to reduce the need to maintain funds just for medical purposes. If insurance does not give individuals such assurance, 'it is not of much value as an insurance product'.
The Ministry of Health (MOH) has said it is engaging with GE to better understand the impact of its decision to suspend pre-authorisation certificates for Mount Elizabeth hospitals.
In its reply to queries from the media on June 19, MOH said IP insurers 'would have to ensure that policyholders continue to be able to access the full benefits of their policies in accordance with the terms and conditions for claims, as stated in their policy contracts'.
SAS' Mr Lee said GE is not in breach of contractual obligations.
This is because 'issuance of Certificate of Pre-authorisation is at Great Eastern's discretion', according to the policy contract that SAS has sighted.
According to GE's website, the insurer states that it has 'observed that, over the past few years, certain private hospitals have been charging significantly more for similar treatment or the same clinical outcomes'.
Mr Lee noted that by withdrawing pre-authorisation for the two hospitals, GE hopes that it will help address 'the issue of rising charges from the two hospitals'.
Prof Chen from the NUS Business School said that GE is prioritising healthcare providers that offer high-quality care and better cost management, specifically those that are more cost-effective and transparent about pricing.
Having looked through the financials of all the IP insurers which filed their latest 2024 results with the Monetary Authority of Singapore, Havend's Mr Ng said he can see that GE is 'trying to control the cost levers' within its control.
The insurer posted an underwriting profit in 2024 of $4.8 million, after making an underwriting loss of $44.9 million in 2023.
This makes GE one of the three IP insurers which turned in a profit in 2024. The other two are Prudential and AIA.
Three other IP insurers, Singlife, Income and HSBC Life, widened their underwriting losses while the last one, Raffles Health, narrowed its underwriting losses.
Mr Lee said that insurance, especially in cases requiring little or no out-of-pocket expense, strengthens policyholders' sense of affordability.
Demand induced by this stronger sense of affordability can drive up medical costs, he noted, adding that this never-ending cycle of medical cost inflation can be broken if the sense of affordability gets meaningfully dampened.
However, Mr Lee pointed out that there are other factors such as shortage of medical professionals, supply chain disruptions and medical innovations that will drive up medical inflation.
He added that if medical costs continue to rise, insurers will have no choice but to raise premiums because there is hardly any pricing buffer left in the rates being charged.
Mr Lee said: 'At its core, this pre-authorisation withdrawal aims to address rising medical costs that, if poorly controlled, lead to premium rates spiralling upwards in future.'
Prof Theseira added: 'This certainly could be perceived as a shot across the bow for private hospitals and doctors who have higher than average charges.
'If the decision changes patient behaviour, it would pressure private healthcare providers to moderate charges or risk similar actions being levied against them by other insurers.'
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Underserved market Seniors are a sorely underserved market Ms Chia wants to tap. Ageing is a US$4.56 trillion (S$5.84 trillion) market opportunity in the Asia-Pacific region in 2025, with Singapore's market potential estimated to be at US$72.4 billion, says Ms Chia. She is also the founder of Ageing Asia, an ageing-focused consultancy that is behind the 16-year-old annual World Ageing Asia Festival. In June 2025 , Aspire55's community brand, Singapore Seniors, became the active ageing operator for Commune@Henderson, Singapore's first intergenerational co-living space that houses seniors as well as foreign students. It was developed by TSTAP, a joint venture between dormitory operator TS Group and co-living provider The Assembly Place. Under Commune's community ambassador time-share model, seniors organise and teach activities such as painting and gardening in exchange for access to a personalised circuit strength gym programme similar to Aspire55's version . Students living there also help to teach the older adults tech-related classes, among other activities. Ms Chia hopes to replicate the concept of an intergenerational gym in private condominiums here, which often see their gyms empty during office hours. While condos usually have seasonal programmes for residents, she wants to create regular opportunities for young and old to interact meaningfully. 'This is a cost-efficient, scalable way to bring our model closer to homes,' she says. At Vigeo Personal Training's 1,900 sq ft gym in YWCA Fort Canning, members do not have to wait for their turn at a weight machine or search for missing dumbbells. Its 'gym within a gym' concept has pods containing the equipment they need for their workout, almost like a business-class version of the usual gym set-up. Mr Benson Poh, director of Vigeo Personal Training, helping Ms Julia Tey during a training session. It has a 'gym within a gym' concept, with pods that contain all the equipment members need. ST PHOTO: GAVIN FOO And unlike gyms which have a wall of mirrors, the ones here are strategically placed as semi-private partitions along the middle of the gym to make shy clients feel more at ease. Most of Vigeo's clients are above 50 years old and many have medical conditions such as osteoporosis, sarcopenia, diabetes and general muscle weakness, says its director Benson Poh, who started the business six years ago. He declined to reveal his membership figures. It offers semi-private personal training, in which a coach takes care of two to four clients in a session and each can access his or her customised workout using a tablet at his or her pod. Fees start at $105 a session and members are encouraged to attend twice weekly. 'Gyms have always been about aesthetics, but we are trying to improve quality of life and help people stay healthy into their 60s, 70s and beyond,' Mr Poh says. That also means challenging stereotypes of what kinds of exercise seniors can do, while being mindful of their injuries and health issues. 'If you treat old people like old people, they will be old people. A lot of times, senior training is about taking it slow because you're very frail. But we want to challenge them to the best of their abilities,' he adds. One of the most heart-warming cases he has handled was a woman in her 70s who wept with joy after she was strong enough to get up from the floor, something she had not been able to do since knee replacement surgery. Part-time teacher Julia Tey, 50, signed up at Vigeo in November 2023 when she began gaining weight in perimenopause despite running and doing yoga stretches regularly. After strength training for a while, she realised she had to buy clothes in a bigger size as her muscles developed, but it triggered a 'mindset shift' from the perception that women must be stick-thin like K-drama actresses. 'Since gym training, I run better and feel independent and strong, physically and mentally. My back doesn't hurt when I try to carry something,' she says. 'I shamelessly feel like I'm 30 again.' Physiotherapy practice Thrive Healthcare launched its Legends programme in 2019 because it saw a gap in the market. The programme helps older adults with diverse medical conditions develop functional fitness, strength and conditioning, says physiotherapist Lenis Phoa. It has around 100 active members ranging from 50 to 91 years old, who can choose from its schedule of eight one-hour classes. Most attend once or twice weekly. Prospective members must attend a trial class at $35 to see if they are suitable. Packages start at $225 for five sessions and there is a couple package for spouses as well. Ms Phoa says the programme initially focused on safety and engagement for a diverse group of clients, but has since evolved to include a data-driven approach to track improvement, fitness and health education, as well as community building. One success story is Madam Cheok Soh Cheng, 74, who suffers from multiple health conditions. After joining the programme in July 2024, she has improved her health and gained energy and confidence, so much so that she is looking forward to taking part in the gym's in-house competition in Augu st. Madam Cheok Soh Cheng, 74, who suffers from multiple health conditions, has improved her health and gained energy and confidence after joining Thrive Healthcare's Legends programme for seniors. PHOTO: THRIVE HEALTHCARE Mr Li m from Lien Foundation says private gyms such as these serve a different segment of the silver market. He hopes all future Active Ageing Centres will include a dedicated seniors' gym. 'Their rise signals a positive shift towards ageing well – offering safe, peer-supported spaces for seniors to begin strength training. It is a fast-growing space. 'As seen in Finland and Japan, more players can drive innovation and help make strength training a norm for seniors, not the exception.'
